When the Heart Fails: A Hospital in Crisis
The electrocardiogram told the story no one wanted to hear. The ejection fraction wasn’t improving. The device was doing its job — barely — keeping her alive, buying time for her heart to remember how to beat after the cardiomyopathy had stripped it of its strength. But for now, all they could do was watch. Monitor the ejection. Gauge the contractility. Wait.
“What if she doesn’t recover?”
The question hung in the air, unwanted, unwelcome.
“Don’t think about that right now. Let him talk.”
The official stance, spoken aloud, was that a permanent solution would eventually be needed. A transplant, perhaps. One minute, please. But as Warren had said, the worst-case scenario wasn’t something they could afford to entertain right now. It had only been hours. One minute. Say goodbye to my wife. Doctor Bailey.
A glance at the clock. Late for the next consult. Keep it brief.
Harbor General in Tacoma was running the same clinical trial Katie was on. The news landed well — until the catch. There was always a catch. The drug was a compound mixture, unstable for transport. Katie would have to go there to receive it.
That wasn’t a problem. Have a safe trip.
Wait. Doctor Bailey wanted her to drive Katie there? Adams was not cleared to drive. And if she thought renting a car and handling it herself was the solution, she had clearly misunderstood her assignment.
“Shouldn’t we take her by ambulance?”
“I have other patients.”
“The interns can cover you. That’s what they’re here for. Kat is a valuable cargo. I expect you to treat her as such.”
Okay.
The cholangiopancreatography — normally a 24-to-48-hour protocol. But this patient had already been through so much. There was a fear the drainage wouldn’t work. Better to know now. And what was that? The bile duct was shifting.
Wait for the antibiotics to calm the cholangitis. It was going well, actually.
“Can I ask about Mr. Elmer’s tests?”
There was fluid accumulating adjacent to the tumor. Not bile. Not bloody fluid near the bile ducts. Something else. Something that looked wrong. Possibly a hemorrhage from the tumor itself. They’d need to repeat the coagulation studies. Ultrasound. Now.
Hydrogel?
“Who placed the gel?”
“I injected it when you left. It was his best option. It was just… sitting there in the hospital.”
“His best option was for you to commit a crime with my patient in my operating room?”
“Okay, but no one has to know.”
“Yes, they do. Queen has to know. You can’t implant an experimental treatment into a man’s body and not tell him.”
“Okay, fine. I’ll tell him.”
“No. You’ve done enough.”
A gasp. She lost speech. The left side of her face went slack. Confusion set in. They intubated.
“Owen, you can’t be here.”
“I’m not going anywhere.”
There it was. A clot. First segment of the middle cerebral artery. Lucky she was with someone who acted immediately. Vascular strokes had a high mortality rate. Thrombolytics? She’d already received anticoagulants. The best bet was surgical removal. Prep her for an endovascular thrombectomy.
“I’m going to treat her like she’s my own mother.”
A review of her history revealed she hadn’t updated her advance directive in over a decade. Had her wishes changed? If that moment came…
“I don’t think about that. Only you.”
The stenosis. There was no time. He’d be notified when there was news.
Helm wanted Irene’s latest blood gas results. The numbers were improving. Good sign, right? Except the hemoglobin kept dropping. Hemorrhaging somewhere. Could be dilutional. Could be something else. Maybe it wasn’t a health issue at all. Maybe she just needed more time.
But if the bleeding wasn’t coming from the uterus, there might not be more time. The only option left was to open her up. Get into the OR. Find the source before it found her first.
In the hallways, in the operating rooms, in the quiet spaces where decisions are made between one breath and the next — the hospital was a pressure cooker, every case a ticking clock, every patient a life balanced on the edge of a scalpel’s blade. And somewhere in the middle of it all, someone was asking the question no doctor ever wants to answer honestly:
What happens when waiting isn’t enough?