cerebral cortex, the thinking part of her brain, was no longer influencing the movements of her body. Harry watched, stunned.
“We’ll get a CT scan,” Cohen said grimly, “but in all honesty, I don’t think we can get her to the OR. The brain swelling is enormous. Both of her optic discs are showing severe papilledema.”
Papilledema
—the optic nerve engorgement caused by marked, usually irreversible pressure within the skull. The finding made the evolving scene even more surreal.
“She … she doesn’t want any heroic measures,” Harry heard himself saying.
“Arterial line’s in,” another resident called out. “Her systolic is still two-ninety.”
“That’s very strange,” Cohen said. “We’ve given her a huge amount of antihypertensives already, but her pressure hasn’t budged.”
“But wouldn’t you expect her pressure to be up like this with a large hemorrhage?” Harry asked.
“Temporarily, maybe. Most CNS bleeds do have a period of marked rise. But they almost always respond toconventional treatment, and the residents have already gone well beyond that.”
“Oh, God,” Harry whispered, still feeling detached and unreal.
“We’ll keep trying to get her pressure down,” the neurosurgeon said. “And we’ll get a CT to document what we already know. Meanwhile, Harry, difficult as it is under these circumstances, there’s something you should be thinking about.”
“I understand,” Harry murmured.
Evie was a young, completely healthy woman, whose only organic problem was her aneurysm. At the moment, she was the sort of prize coveted by every organ transplant specialist—a source of life or sight for any number of people.
“Let’s get the scan and then I’ll let you know,” Harry said. “Meanwhile, go ahead and begin tissue typing.”
CHAPTER 7
After half an hour, the battle to control Evie’s astronomical blood pressure was finally won. But everyone involved in the case knew that the war had already been lost. Harry stood helplessly by the door as the respiratory technician adjusted the controls on the ventilator that was now Evie’s only link to life. There were IVs in both her arms and tubes into her stomach, bladder, and lungs. Every minute or two, in response to nothing in particular, her entire body would tighten and extend into a decerebrate posture. This nightmarish scene was one he had witnessed many times in his professional life and in Nam. But emotionally he had never become very adept at dealing with it.
There was inevitably a part of him unwilling to accept the simple truth that it was over.
Wait. Give me another five minutes. Just be patient. This woman’s going to get right up and walk out of here.… You’ll see
.…
“No, thank you,” he replied to a nurse who offered him coffee. “I … I’ve got to call Evie’s folks.”
He glanced at the corridor behind him. Maura Hughes seemed calmer. Her brother, a carrottop with a face too youthful for the uniform he wore, continued stroking her hand as he watched the unfolding horror in room 928. It was quarter of eleven. The CT scanner would be free in five minutes. Blood samples had been sent off to the lab for tissue typing. On the way back from the CT scan, assuming nothing had come up that would send her to the operating room, Evie would get the first of what would probably be a series of electroencephalograms. Two flat or near flat EEGs twelve hours apart were considered to be the electrophysiologic equivalent of death. Harry reached up unaware and brushed aside a tear that had worked its way to the top of one cheek.
“Corbett, what in the hell is going on here?”
Still half-dazed, Harry turned toward the voice. Caspar Sidonis stood several feet away, hands on hips, his expression pinched and angry.
“I don’t know what you’re talking about,” Harry managed. “But right now I’m a little busy. You see, my—”
“I’m talking about Evie, dammit!” Sidonis snapped. “Oh, never
“We’ll get a CT scan,” Cohen said grimly, “but in all honesty, I don’t think we can get her to the OR. The brain swelling is enormous. Both of her optic discs are showing severe papilledema.”
Papilledema
—the optic nerve engorgement caused by marked, usually irreversible pressure within the skull. The finding made the evolving scene even more surreal.
“She … she doesn’t want any heroic measures,” Harry heard himself saying.
“Arterial line’s in,” another resident called out. “Her systolic is still two-ninety.”
“That’s very strange,” Cohen said. “We’ve given her a huge amount of antihypertensives already, but her pressure hasn’t budged.”
“But wouldn’t you expect her pressure to be up like this with a large hemorrhage?” Harry asked.
“Temporarily, maybe. Most CNS bleeds do have a period of marked rise. But they almost always respond toconventional treatment, and the residents have already gone well beyond that.”
“Oh, God,” Harry whispered, still feeling detached and unreal.
“We’ll keep trying to get her pressure down,” the neurosurgeon said. “And we’ll get a CT to document what we already know. Meanwhile, Harry, difficult as it is under these circumstances, there’s something you should be thinking about.”
“I understand,” Harry murmured.
Evie was a young, completely healthy woman, whose only organic problem was her aneurysm. At the moment, she was the sort of prize coveted by every organ transplant specialist—a source of life or sight for any number of people.
“Let’s get the scan and then I’ll let you know,” Harry said. “Meanwhile, go ahead and begin tissue typing.”
CHAPTER 7
After half an hour, the battle to control Evie’s astronomical blood pressure was finally won. But everyone involved in the case knew that the war had already been lost. Harry stood helplessly by the door as the respiratory technician adjusted the controls on the ventilator that was now Evie’s only link to life. There were IVs in both her arms and tubes into her stomach, bladder, and lungs. Every minute or two, in response to nothing in particular, her entire body would tighten and extend into a decerebrate posture. This nightmarish scene was one he had witnessed many times in his professional life and in Nam. But emotionally he had never become very adept at dealing with it.
There was inevitably a part of him unwilling to accept the simple truth that it was over.
Wait. Give me another five minutes. Just be patient. This woman’s going to get right up and walk out of here.… You’ll see
.…
“No, thank you,” he replied to a nurse who offered him coffee. “I … I’ve got to call Evie’s folks.”
He glanced at the corridor behind him. Maura Hughes seemed calmer. Her brother, a carrottop with a face too youthful for the uniform he wore, continued stroking her hand as he watched the unfolding horror in room 928. It was quarter of eleven. The CT scanner would be free in five minutes. Blood samples had been sent off to the lab for tissue typing. On the way back from the CT scan, assuming nothing had come up that would send her to the operating room, Evie would get the first of what would probably be a series of electroencephalograms. Two flat or near flat EEGs twelve hours apart were considered to be the electrophysiologic equivalent of death. Harry reached up unaware and brushed aside a tear that had worked its way to the top of one cheek.
“Corbett, what in the hell is going on here?”
Still half-dazed, Harry turned toward the voice. Caspar Sidonis stood several feet away, hands on hips, his expression pinched and angry.
“I don’t know what you’re talking about,” Harry managed. “But right now I’m a little busy. You see, my—”
“I’m talking about Evie, dammit!” Sidonis snapped. “Oh, never
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