‘Percutaneous sheath, bipolar pacing catheter and bridging cables and pacing box.’ She murmured the contents out loud, mentally ticking them off in her head.
Gene spoke quietly to Aryssa. ‘Aryssa, I know you might be feeling light-headed. We’re sure that your pacing wire has moved. We’re going to insert a temporary pacing line to get your heart back on track. You’ll probably be a little woozy until we get this sorted. But trust us. We’ve got this.’
Aryssa’s eyes were closed but she tossed her head from side to side. ‘But I’ll be flung off the trial. I don’t want that. The drug is the only thing that’s worked for me.’
Gene met Cordelia’s gaze. Her heart gave a little flutter inside her chest and that made her freeze. Oh, no. Not now. Not here.
He spoke smoothly. ‘Aryssa, with a heartbeat of around forty we couldn’t let you stay in the trial. We’ve got to keep you healthy. This isn’t something we can debate. You need this procedure.’
A tear trickled down Aryssa’s cheek and Gene clasped her hand tightly while looking at Cordelia. It was awful. Aryssa had been doing so well on the trial. The new drug seemed to be having a good effect on her. Her symptoms had diminished over the last few weeks and up until the last day her heart function had looked a little better.
Hypertrophic cardiomyopathy could throw up a whole host of problems, depending on which part of the heart was most affected. Right now, they had no way of reversing the condition, but this drug had actually looked as though it could slow and stabilise the condition, optimising the output of the heart.
Gene looked so conflicted. She could almost see what he was seeing—Rory on the bed instead of Aryssa. It must be breaking his heart.
For a few seconds his dark brown gaze intersected with hers. He wasn’t a doctor right now, he was a parent. It was like seeing the window to his soul. His hopes and fears all tumbling over and over. She gave him the briefest nod of acknowledgement and it was almost like flicking a switch.
His doctor face fell back into place.
‘What site?’ asked Gene.
Cordelia breathed deeply, focused and ran her eyes over her patient as the sonographer appeared. She gave him a grateful smile and a nod as he moved into position without even speaking.
She looked at Aryssa’s neck. There was a small white scar at her neck—obviously the place of the last insertion. The right internal jugular vein was the preferred option due to the ease of positioning the wire into the right ventricle. But since it had already been used there was a risk of scar tissue. She wanted this procedure to go smoothly.
She could see Gene’s eyes following hers. ‘Looks like the left subclavian is our best option,’ she said.
The nurse gave a nod and eased Aryssa’s gown down from her left shoulder, giving easy access to her left clavicle and covering around the area with sterile drapes. Cordelia picked up a swab and cleansed the area, feeling with her fingers for the identifying features. She then nodded to the sonographer, who placed his probe just under the clavicle, allowing her to identify the artery and vein on the screen. As the artery and vein were so close it was important to familiarise herself with the patient’s anatomy.
She waited until the arterial wave form was shown, to differentiate between the artery and vein, then injected some local anaesthetic into the site.
Gene’s voice was low and reassuring in the background. He talked to Aryssa the whole time she lay with her eyes closed, keeping a soft grip of her hand.
Cordelia threaded the dilator into the catheter, attaching it to the needle and inserting it, waiting for the flash of blood, before continuing. She held the needle steady while advancing the wire into the vein. She then removed the needle, made a little cut with the scalpel and inserted the sheath, with the dilator in place, over the wire.
‘Almost done,’ she said quietly to Aryssa. ‘I’m just removing the wire and testing the balloon on the pacing wire.’ That only took a few minutes then she completed the procedure by inserting the wire into Aryssa. The wire was attached to the pacing box and it turned on. They watched on the screen as the balloon allowed the wire to be positioned. A few seconds later the pacing spikes appeared on the monitor, showing them that the wire was in the correct position.
Cordelia still marvelled at the technology they had these days that allowed them to do relatively complicated procedures in such a quiet and controlled environment. They waited another few minutes, watching the monitor for any potential changes. It only took a few seconds for Gene to smile and nod and for Aryssa’s cheeks to start to pink up. Her heart rate was now sitting at around seventy beats per minute. The pacing wire was doing its job.
They held steady. Waiting to ensure that everything was in place.
That was when it started. The noise like horses’ hooves in her ears. That feeling of a runaway train in her chest.
No. Please, no.
She stared down at her gloved hands, wanting to lift one to her neck. But she couldn’t. This was a sterile procedure.
She tried to take some long, slow, steadying breaths. But it was useless. She knew that. She’d dealt with this condition too long.
She kept her voice as steady as it could be. ‘Dr Du Bois, would it be possible for you to stitch the line in place for me, please?’
The nurse next to her turned her head in surprise, and Gene looked up. He gave her the strangest look. Stitching only took a matter of minutes—minutes that she didn’t feel like she had right now. It seemed odd to ask another doctor to scrub and get sterile. It would take him longer to do that than it would for her to do the stitching. But her head was starting to swim. She had to get out of here. Now.
She didn’t wait for his answer. She just turned to the nurse next to her, who was already gowned and wearing sterile gloves. ‘Could you hold this for me until Dr Du Bois is ready, please? I need to get a little air.’
The nurse moved swiftly, sliding her hands over Cordelia’s so there was no change in position. Cordelia didn’t hesitate. She turned and left as the thudding in her chest threatened to overtake her. She heard someone call her name. But she couldn’t afford to wait.
Her legs were shaking almost as much as her head. Heat swamped her and she tugged the sterile gown from her throat and sterile gloves from her hands as she staggered the last few steps to her office.
It was like a sanctuary. She didn’t even have time to close the door but slid down the wall, automatically putting her fingers to her neck to start massaging.
It was all she could think about. All she could concentrate on. Every molecule in her body had to think about those fingers. It was her own fault. She’d never left it this long before. She always dealt with the arrhythmia as soon as she’d felt it. As soon as she’d had symptoms.
She counted in her head. Slowly. One...two...three. It was impossible. Counting wouldn’t slow her heart rate. Or stop the wooziness in her head. Or the tightness in her chest.
She pictured something else. Green meadows. For as far as the eye could see. Flat green meadows. Dotted with daisies and dandelions. She sucked in a long, slow breath.
This was the place she liked to see when she needed to.
