Make It With You

35

After many hours...

"She has a hole in her heart."

"She needs a bypass to fix it, and she needs it now."

"The bypass would mean a lot of heparin. That's a setup for a re-bleed."

"The hypothermia... it could kill her."

"Traumatic V.S.D.s can sometimes close on their own."

"Then why should we wait to repair it?"

"She's not stable enough to wait."

"Her pressure's bottoming out. Belly's tight as a drum. Flash pulmonary edema. Her lungs are full of fluid."

"Abdominal compartment syndrome. She's bleeding out. Alert an O.R. that we're on our way down."

"Got some new bleeding."

"Remove the abdominal packs carefully. They may be stuck."

"Irrigation."

"I'm starting to cannulate."

"Slowly push the heparin."

"We've got blood!"

"Damn it. We've gotta go back in."

"It's the heparin. We need to reverse it and try the percutaneous repair."

"Get me a percutaneous catheter kit."

"Flip on the echo. I'm going up through the groin."

"Removing the needle over the guidewire."

"Catheter. Forceps. Suction, Dr. Koo."

"It's going in easy. Get the T.E.E. ready."

"Still got some active bleeding coming from somewhere."

"Well, then let's recheck the retroperitoneum."

"I've got access."

"Forceps. Give me some suction. Clamp and give me a tie, please."

"The brain is decompressing. The balloon is advanced."

"Extra-stiff guidewire, please."

"Brain bleed has been controlled."

"Okay, the occluder's in. Turn on the Doppler."

"Minimal residual V.S.D. flow. Good."

"Then we're done here."

"Pulling out. I've got a lumbar vein avulsed in the vena cava. Two allis clamps."

"Idioventricular rhythm."

"Damn it. She's bradying down."

"Pressure's down. 55 systolic."

"Push one of atropine."

"C.V.P. and pulmonary artery pressures just went up."

"It might be an air embolus."

"Pull back on the P.A. catheter."

"Hang more F.P. and factor VII."

"We're losing her."

"We've already replaced her entire blood volume."

"Starting cardiac massage."

"Push one of epi."

"Find whatever's bleeding and shut it down."

"How about an amp of bicarb?"

"Push 3 of epi and another atropine."

"Come on. Come on!"