Do No Harm

She paused for an instant, her gloved hand hovering near the gap. David had walked her through this move on a cadaver, but she'd never had a live run. She looked up, her brilliant green eyes catching David's, and he nodded once, reassuringly.

Lowering her shoulder, she slid her hand into the man's living body.

"You feel the lung along the back of your hand?" David asked. "Bumpy and soft?"

She nodded. "I have my bearings."

Her arm disappeared midway to her elbow as she slid her hand down along the inside of the man's back.

David's hand twitched at his side as he mentally undertook the maneuver with her. "Did you check the aorta?"

She shook her head.

"How can you restrain yourself?"

Her eyes widened. "I've got it!" A smile bloomed on her face, a child's smile at sighting something wondrous. "Under my fingertips. It's firm and full of blood."

"Good," David said. "Now let's check for a pericardial tamponade." If the heart had sustained a trauma, which David guessed it had from the angle of the rebar, it was probably bleeding into the pericardium. And if the sac around the heart filled with blood, it would interfere with the heart's mechanism, preventing it from pumping effectively.

Someone banged into a rapid infuser and it nearly capsized.

"Where the hell is surgery?" Diane said. She readjusted her hand, and a soft sucking noise emerged from the wound.

"It's all right," David said. "Focus on the task."

Diane twisted her body so she could better maneuver her hand. "Got it! The pericardial sac is full and tense. The heart must've bled into it."

She removed her right hand to grab a tiny pair of scissors, picked up a pair of tongs with her left, and went back in with both.

"Okay," David said. "Grab the edge of the sac with the tongs and make a small vertical incision." He strained to look around her and saw blood spill into the chest. "Good. Now deliver the heart."

Her arm moving with exquisite care, she gripped the heart and pulled it out through the small incision, holding it in her hand. "It's beating," she said, ducking her head to see through the mess. "It's got a small hole."

"It's trying to push blood but can't. Put your thumb over the hole."

She adjusted her thumb, then turned and looked to David again. He held her gaze as they waited. Now that she'd plugged the heart's hole, blood should begin pumping more effectively. A nurse near the man's head looked up triumphantly. "I got a pulse!" A carotid pulse meant the blood pressure had just hit sixty.

"Me too!" another nurse exclaimed. "Femoral pulse!" The blood pressure had risen to seventy.

A wisp of hair fell across Diane's eyes, and she flicked it aside with a quick jerk of her head. Her lips were trembling ever so slightly-David was sure he was the only one who noticed. Her face had taken on the fervent, confounded cast of one in extreme grief or ecstasy. She held a man's beating heart in her hand, and her thumb plugging its hole was the only thing keeping him alive.

The junior surgeon jogged into the room. "Call OR," Diane said. "Tell 'em we're on our way."

The gurney took off with a lurch as Jill shoved it toward the door, several others grabbing for the connecting gear and making sure it moved with the body.

Keeping her thumb firmly pressed over the hole in the heart, Diane threw one leg over the man's body as she hopped on the gurney. David stepped back as the gurney and its attendant mob swung out into the hall and rattled along at an impromptu sprint, the junior surgeon barking orders, nurses dragging rapid infusers on IV poles, and Diane straddling the patient's unconscious body, her arm inside him, seeming to ride the entire mob like a cowboy.

Looking up across the bobbing heads and waving poles, she caught David's eye. She winked just as the gurney turned the corner, and he realized he was in love with her.

Chapter 34

AFTER checking that Clyde's composite was indeed being circulated through internal mail, David rode up to the fifth floor and entered the ICU ward. It was busier than the last time he'd visited Nancy, two days ago. A frail woman called out to him from a bed, wanting more morphine, and he smiled at her as he passed. "I'm sorry, ma'am, I don't work in this department, but I'll get the nurse for you."

The curtains were drawn in a tight oval around Nancy's bed, like a coffin pall. The rattle of the rings woke her. She turned her face, and he did his best not to let his horror show despite the fact that she couldn't see him. If shock found its way into his face, it would find its way into his voice.