LITMIR.BIZ

Скачать книгу

put her hand on Aryssa’s shoulder. ‘Aryssa, how are you feeling?’

      The heart rate on the monitor seemed to rise for a few seconds. ‘Not good,’ she whispered.

      Cordelia nodded. ‘Don’t worry. We’ll look after you. But has anything happened in the last day or so that could have dislodged your pacing wire?’

      Aryssa lifted her hand to her chest. ‘I had an accident in the car on the way to the institute this morning. It was only a small bump, but the airbag exploded.’

      Gene shot Cordelia a look. ‘Did the airbag hit you?’

      Aryssa winced. ‘Yes. But I got more of a fright because of the noise. And the powder.’ She closed her eyes again, obviously exhausted just answering those few questions.

      They moved outside into the corridor.

      Gene didn’t hesitate. ‘That’s enough for me. We need to insert a new pacing wire. She’s too symptomatic to move her elsewhere.’

      It was the weirdest feeling. All of a sudden she almost felt as if she were a spectator instead of part of the situation. As if she were dangling up somewhere in the corner of the room, watching everything.

      She couldn’t remember the last time there had been an emergency in the clinic. Not like this anyway.

      Everything she’d ever learned at medical school decided to fly out of her head in an instant. She couldn’t tell a clavicle from a femur, or an atrium from a liver lobe.

      Crap. She’d never panicked as a medical student. She’d always been one of the calmest in the class. While others had fainted at the sight of blood, or any other body fluid, Cordelia had just wondered why on earth they wanted to be doctors.

      So what was wrong with her now?

      One of the clinic nurses appeared at her side. ‘Are we pacing?’

      Simple words. And that was all it took. Her brain shifted gear.

      Gene walked into the next-door cath lab. His actions were automatic. It was clear he’d dealt with this situation before. He pulled over a trolley and set out the equipment. He nodded to the nurse. ‘Can you bring the patient in, please, and we’ll explain what we need to do.’

      Cordelia moved over to the sink and started scrubbing her hands. A temporary pacing wire wasn’t performed in a traditional operating theatre, but the cath lab was as good as it got around here. The wire went straight into a central vein, and everything had to be done aseptically to protect the patient from infection.

      The nurse wheeled Aryssa in. She was lying on her back, her face pale and sweating. She was already attached to a portable cardiac monitor showing her very slow heartbeat and low blood pressure.

      Gene gave Cordelia a nod. He moved over and took Aryssa’s hand. He mouthed one word to her. ‘Cold.’

      Cordelia pressed her lips together. Cold extremities meant that the blood flow just wasn’t getting enough power to circulate properly. She dried her hands and held them out in front of her to where the nurse was holding out a disposable surgical gown. Next came the gloves then she checked the equipment on the trolley.

      ‘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

Скачать книгу