Page 21 of Paging Dr. Breakup
Three more pulsations. He expected to see blood squirting from between the sutures.
He gritted his teeth.Hold, goddammit.
“Can you dab that area, please?” His voice came out shaky. Hopefully no one noticed or thought poorly of him for it.
“To be honest, I don’t want to touch it,” Deirdre said.
Despite the situation, he chuckled. She didn’t realize how much her quiet confidence grounded him in this situation.
“Hey, I don’t blame you one bit.” He met her bright blue stare, and the tension between his shoulder blades eased. “But we have to.”
She dabbed the suture line and surrounding tissue. No bleeding from the vessel. Only a small amount of oozing came from damaged but now re-perfused muscle. His heart lodged in his throat. Had they really done it? “I think it’s good.”
“Way to go. You might make a solid surgery intern before you’re all done.” Dr. Yang laughed. As everyone in the room took a deep breath, Dr. Yang intoned, “You’re not quite done. The location of injury has a high risk of tearing the nearby femoral vein and femoral nerve. See if you can isolate and check those structures.”
He and Deirdre both sucked in twin deep breaths and bent their heads in unison, studying the exposed tissue. The vein was lateral to the artery and—he carefully dissected around it enough to visualize it and gingerly move it with vascular forceps—patent. The nerve? He found a remnant of the off-white millimeter thick nerve below the injury site. Torn.
“Where’s the other part?” he muttered.
Deirdre dabbed and gently pushed tissue back. “Is that it?”
He blinked, willing himself not to anchor his conclusion in the first structure he saw that looked like a nerve. He forced himself to go through the process of looking around and considering what else this could represent. It did look like a nerve. Tracing it proximally a few centimeters, he identified the muscular branches of the nerve. Likely above that, it would come together into the thick main femoral nerve.
Okay. He had both ends of the severed nerve. “Found it, Dr. Yang.”
“If you can reapproximate the endings of that nerve with a stitch, that will reduce the chance of long-term neurological damage to the limb.”
He lifted his hand, wanting to brush sweat from his forehead, but caught himself. There really should be a surgeon here in Yukon Valley twenty-four seven for times like this.
Bending to the task, he placed two sutures into the ends of the severed nerve and snugged them together. “Done.”
“Give the area some good irrigation to make sure you remove any foreign material.”
Deirdre dabbed as he drew up sterile saline in a large syringe and flushed the area several times. The fluid soaked the sterile towels and the bed. A mixture of blood and saline dripped off the vinyl mattress and onto the floor.
“This room looks like a disaster, but the wound, I think, is cleaned out,” he said.
Deirdre’s eyes lit up. “I’ll run interference for complaints from environmental services staff when they try to clean this mess.”
Everyone chuckled. The air in the room seemed less heavy.
Dr. Yang said, “Only thing left to do is release the tourniquet.”
Cal locked onto Deirdre’s wide-eyed stare. “I am one hundred percent certain none of us want to do that, Dr. Yang.”
“I know. But do it.”
“All right. Moment of truth. Clyde, can you reach under the sterile towel and loosen the tourniquet?”
Clyde slowly released the pressure. As blood flowed, completely unimpeded, through the leg, the femoral pulse bounded more vigorously, and the surrounding tissue and distal limb went from pallor to pink in a matter of a few minutes.
“I’ll be darned.” Cal said, then caught himself. “Um, not that I had any doubt whatsoever this would totally work.” He whipped his head around to shoot daggers at the snickering staff.
Deirdre said, “You did it!” Her smile was hidden by the mask, but he could see the happy crinkles next to her eyes.
Dr. Yang interrupted the celebrations. “Great job and all that jazz. All right, friends. Some of us have work to do,” she said dryly. “Irrigate a few more times, then close the defect. Don’t worry about layered closure. Place a pressure dressing over the site. Ship him as soon as you are able, and we’ll be ready for him whenever he arrives. We’ll do follow-up management up here.”
“Dr. Yang. Fantastic assist from hundreds of miles away. We can’t thank you enough.” Cal blew out a huge breath. “Now I know why I’m getting gray hair.”
