The door to the ICU room crashed open. Doctor Claude Wilson followed right behind the technician who pushed the vehicle, a collection of emergency equipment on wheels that no hospital could afford to have in only one room. The University Hospital ICU was fortunate. It had its own cart to share across only the eight ICU rooms. In many hospitals, the daunting expense of nearly a quarter million Pounds Sterling meant that there was only one such unit for the entire facility.
Reaching out to press the cancel button on the shrilling heart monitor, he took one look at the pink and healthy skin of his patient and immediately began to assess which of the EKG leads had come loose. All were secure. He was in the midst of running the unit's diagnostic test when Dr. MacAffee strode through the still-open door.
"What's all this, Claude?" he snapped.
Claude, still watching the machine cycle through its self test, shook his head. "Something's gone bonkers with the monitor, I think." But the monitor finished its test and flashed its green pilot light three times, signifying that all parts of it were properly active, and further, properly connected and sensing.
He watched helplessly as MacAffee did what he should have done first. Holding out his hand toward the nurse, he silently accepted her stethoscope. In moments, he was searching the huge man's chest for the sounds of his heart ... or even of breathing. There were none. Still, his chest and face held this rosy pink color. But that might be a fluke, Claude decided. Like the nurse, he checked that suspicion with a quick fingernail check, which brought the immediate response of a return to color.
The patient was getting oxygenated blood from somewhere, that was certain. But from where? Rounding on the nurse, he nearly blew her off her feet with the forcefulness of his question.
"What the hell did you do to him?"
But the nurse stood her ground. MacAffee looked at the stethoscope in distaste and dropped it on the floor, then leaning over and putting his ear directly against the man's chest, still searching for the elusive sounds he sought. Even as he did so, the nurse responded indignantly to the question.
"I did absolutely nothing untoward! Ask her!" she exclaimed, pointing at Lisa. MacAffee glanced at Lisa, but asked nothing of her. Instead he made a request of the nurse of his own.
"Who is she?" The nurse glanced at the clipboard that hung from the side of the patient table.
"Her name's Lisa Douglas, and she is the medical adjudicator and advocate for this patient, according to a note from the Administrator. Further, she is a medical student. I presume she also has enough sense to do nothing that would harm a patient, either. Am I right?" This last was directed at Lisa, who wordlessly nodded in agreement. The nurse added, "She's just been sitting there, holding his hand. What do you think ... that she's doing magic?"
But Claude was not finished. Feeling himself being put on the defensive, he expostulated, "This is crazy. He was fine when I made my rounds not more than a half hour ago. Look on the chart, you can see where I signed in and out!"
During all of this exchange, the rescue cart technician had been busy. He had the cart plugged into the wall power, all its instruments up and running, and had charged the defibrillator. Standing by it, he held out the gel-slicked paddles toward MacAffee. "Charged and ready for conversion, Sir." But as the surgeon reached for them, he paused. What brought him up short was Lisa's wordless expression. She was staring at the monitor panel.
Whipping around, MacAffee looked there as well. As he searched the display, he suddenly waved the paddles away. There was no smallest trace of a heart rhythm, and the respiration count read a flat zero. But the set of five electrodes that registered brain activity through the EEG monitor ...
Those were active ... very active ...
"He's alive!" his voice gritted out, even while his unbelieving eyes stared at the monitor. Scooping up the nearly forgotten stethoscope, he listened intently again to the huge chest, waving the others to silence. Then he transferred it to the arteries of the patient's left wrist.
At last he beckoned to Claude. "Damnedest thing ... here, you listen!"
Claude took the steth' set and put it to his own ears. Then he listened to the wrist arteries. At first he heard nothing. But then, as his ears acclimated to the silence, he became aware of a faint sound, a hissing, as if something was streaming by the little diaphragm beneath his fingers. Curious, he put a finger against the artery between the steth' and the patient's heart. The faint hissing disappeared. He released his finger pressure and nearly fell off the edge of the bed in shock at the loud "BOOM!" that snapped from the blood vessel as blood rushed back in to fill the now-empty tube.
Bewildered, he looked up at MacAffee. "What the hell ...?"
"He's being continuously perfused. Where he's getting the oxygen, I have no idea. His skin, maybe ... But he's adequately perfused. Leave him alone." The great surgeon slouched over to the wall and leaned against it, ruminating. "Get up. Just get up and leave him be. Just watch ..."
Claude rose and turned to stand, watching intently as did all the others. Into that tableau came murmurs from MacAffee. "He's got blood flow. It's continuous. The only place I ever saw that was with a very old perfusion pump, oh God, years ago. It put out a continuous stream of oxygenated blood instead of one-per-second squirts. Surgeons didn't like it because of that. Seemed to think that blood flow has to be the way the heart normally does it. But the body does not have any real requirement that it must be in pulses. It's blood pressure that counts. Here, you ..."
This last was addressed to the cart technician. "Get a BP cuff on him and hook it up to the monitor." The tech scurried to find a blood pressure cuff and put it into operation. The girl by the window rose to help, placing the cuff with quick and sure movements while the tech made the necessary connections. In seconds the pressure showed up on the monitor screen, but the numbers seemed crazy. His pressure was a constant 85 mm of mercury, both for the high and low readings. Claude shook his head, but MacAffee continued to mutter. "Weird, huh? I wouldn't understand it either, if I hadn't seen that pump demonstrated. But that's exactly what we saw then. I'm telling you, somehow his heart is pushing out blood continuously instead of in heartbeats. That's why we can't hear it, and the EKG can't sense it. Its electronics can't make sense of the rhythms to display a trace. Just watch, now."
For several more minutes they watched in silence.
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