punctuated with tiny hemorrhages.
Thanks . . . thank you very much.
“You planning to actually do anything about this problem?” Crandall said. “I can't stand here and compress these bleeders forever.”
“Where's the blood work?”
“Over here,” the circulating nurse said.
Carl followed her to a stainless steel countertop. She picked up a piece of paper and handed it to him. Quickly perusing the report, he saw that the patient's ability to form a clot was five times slower than normal. And the amount of the main clotting protein in his blood was dangerously low. A new
freshet of sweat pearled out of Carl’s pores onto his forehead. This was
why he shouldn’t have
come. He wiped at the sweat with his arm.
“I guess we'
ve also got peripheral smears . .
“On the computer,” the nurse said, leading him to the work station tied to the blood lab.
The nurse typed in the patient's name . . . Benjamin Rasco. Suddenly, behind them, the cardiac monitor began to stutter. Carl's own heart, already at a trot, kicked up to a canter. He glanced over at the monitor. Wrong angle . . . he couldn't read it.
“Heart slipping into ventricular tachycardia,” the anesthesiologist said, in a gas passer's usual
Oh great . . .
Not only was he bleeding to death, the lack of blood was now starving his heart.
“Damnation, what are you waiting for?” Crandall yelled. “Get your ass moving.”
“Doctor, the images are ready.”
Carl looked back at the work station computer screen and saw a menu to choose from. He clicked on the first image from the preoperative smear, and the most bizarre red blood cells he'd ever seen flicked up on the screen. Instead of smooth contours, each of these reds had a large blister on them. He clicked on the second pre-op image and saw the same thing. What the hell? Then something in the room changed. The cardiac monitor . . . it was back to a normal sinus rhythm. They'd just gained some time, but probably damned little.
Focus . . . focus . . .
He clicked on the first image taken from a smear made after the uncontrolled bleeding began. Now, the picture was totally different. Instead of intact red cells, there were only fragments. That confirmed it. Shit. The guy on the table had DIC . . . Disseminated Intravascular Coagulation . . . coined Death Is Coming by those who had to deal with it.
The trouble started when the patient’s blood suddenly began clotting all over his body. The clots
blocked the tiny vessels in all his organs. Thousands of little pieces of him were now dying. With all the clotting factors in his blood consumed by the clotting process, blood was also leaking from the damaged vessels. His reds had fragmented as they were forced through the clots. Carl had encountered five cases of DIC in his career. He had prevailed in all of them, becoming widely known as the best blood doc in town. Crandall knew it. That's why he'd asked for him and not someone else. But stay in the ring long enough and even the best will catch a haymaker in the face. Carl's keen awareness of that was why he didn't want to be there. After losing two patients to leukemia and another to a bacterially contaminated blood transfusion in the same week, he had closed his practice, needing to be finished with battles where other lives were at stake. Yet here he was again, up against a clotting problem that shouldn't even be happening. So why
it? And what's with those sores . . . and the weird red cells?
Can't dwell on any of that now.
He returned to the operating table. Rasco's heart was still banging out a normal sinus rhythm. Despite being given plasma expanders,