Chapter 2 - The Ride to St. Catherine’sThe ambulance doors slammed shut before Margaret found her voice.
“I’m coming.”
“No room,” the paramedic said.
Margaret looked at me as though the laws of physics should make an exception for her.
“I’m his sister.”
“And she’s medically necessary,” the paramedic replied, pointing at me.
I almost corrected him.
Technically, I wasn’t necessary.
Arthur was in capable hands.
But then the monitor changed.
Three rapid beats.
A pause.
Then another run of ventricular tachycardia.
I climbed inside.
“Emily!” Daniel called.
I looked back.
“Bring her.”
He nodded.
The doors closed.
Arthur lay beneath harsh white lights with oxygen running and adhesive pads across his chest. The paramedic beside him was competent, calm, fast.
“What do you think?” he asked.
“Acute coronary syndrome until proven otherwise. Possible left main or proximal LAD. He arrested at the club.”
“You got ROSC?”
“Yes.”
“How long down?”
“Less than two minutes.”
Arthur groaned.
I leaned over him.
“Arthur?”
His eyes opened slightly.
“Well,” he whispered, “dinner got exciting.”
I laughed despite myself.
“Try not to talk.”
“Bossy nurse.”
The paramedic glanced at me.
I said, “Long story.”
Arthur’s mouth twitched.
Then he grimaced and grabbed his chest.
The rhythm changed again.
I watched the screen.
“Arthur, stay with me.”
He looked frightened now.
That mattered.
People imagine surgeons get used to fear.
We don’t.
We simply learn how to function while someone else is experiencing the worst moment of their life.
I had watched hundreds of patients realize that their bodies had suddenly betrayed them.
Fear looked different on everyone.
On Arthur, it looked almost apologetic.
“Margaret,” he whispered.
“She’s coming.”
“Don’t let her organize my funeral.”
“You’re not dying.”
“She’ll choose terrible flowers.”
“Arthur.”
“White lilies. I hate lilies.”
His eyes closed.
“Arthur?”
No response.
The monitor screamed.
“V-fib,” the paramedic said.
We shocked him once.
Nothing.
Again.
Rhythm.
Pulse.
Barely.
“Call ahead,” I said. “Activate cath lab and CT surgery.”
The paramedic looked at my ID after I pulled it from my purse.
His eyebrows lifted.
“Chief?”
“Yes.”
“That’ll make the call easier.”
It did.
St. Catherine’s was already moving before we arrived.
I had spent eleven years there, first as an attending surgeon, then director of complex aortic surgery, and for the past two years as chief of cardiothoracic surgery.
Hospitals look chaotic to outsiders.
To me, a good hospital resembles an orchestra just before a concert.
Thousands of individual movements.
Everyone preparing.
Everyone depending on someone else doing their part.
The ambulance stopped.
Doors opened.
My people were waiting.
Dr. Noah Reed, my senior cardiothoracic fellow, stepped forward.
“Chief.”
“Sixty-eight-year-old male. Witnessed arrest. ROSC after initial CPR and defibrillation, second V-fib arrest en route. Chest pressure radiating to jaw approximately twenty minutes before first arrest.”
He walked beside the gurney.
“Cath team ready.”
“Good.”
Arthur opened his eyes.
“Emily?”
“I’m here.”
“Don’t leave.”
“I won’t.”
We moved through the emergency department.
Nurses cleared doors.
Residents appeared.
Orders were called.
Blood drawn.
ECG performed.
Daniel arrived while Arthur was being rushed upstairs.
Margaret followed him.
Her hair had come loose for the first time since I’d known her.
“Where is he?”
“Cath lab.”
She looked at the medical team surrounding me.
A nurse handed me a scrub cap.
No one explained anything to her.
That seemed to bother her almost as much as the emergency itself.
“What’s happening?”
“We’re finding the blockage.”
“Who is the doctor?”
“Dr. Patel is doing the angiogram.”
“Is he good?”
“Excellent.”
“And the surgeon?”
“We don’t know if Arthur needs surgery yet.”
Her eyes moved to the blood on my dress from where I’d knelt beside Arthur.
Then to the hospital badge clipped onto my purse.
“Emily…”
Daniel stepped between us.
“Not now, Mom.”
“I’m simply asking.”
“No. You’re trying to figure out why you didn’t know.”
Margaret’s lips tightened.
“This is hardly the time.”
“Exactly.”
I touched Daniel’s arm.
“Stay with her.”
“You?”
“I need to change.”
Margaret stared.
“Why?”
Before I could answer, my phone rang.
Patel.
I picked up.
“Tell me.”
His voice was clipped.
“Left main ninety-five percent. LAD diffuse disease, circumflex ninety. RCA seventy. Balloon isn’t going to solve this.”
“How’s his pressure?”
“Dropping.”
“Impella?”
“Placing now.”
“I’m coming.”
I hung up.
Margaret had heard enough to understand my expression.
“What does that mean?”
“Arthur has severe blockages in multiple major coronary arteries.”
Her hand went to her throat.
“But you can put in stents.”
“Not safely enough.”
“What happens?”
“He needs emergency bypass surgery.”
Margaret looked toward the double doors.
“Then get the best surgeon.”
I held her gaze.
“I intend to.”
I turned toward the changing room.
Her voice followed me.
“Emily.”
I stopped.
“Who?”
I knew what she was asking.
Who would operate?
Daniel knew too.
He closed his eyes briefly.
I turned.
“Me.”
Margaret laughed once.
Not because anything was funny.
Because the alternative was believing me.
“You’re a nurse.”
“I was.”
“You told us—”
“You assumed.”
“You let me introduce you that way.”
“I told you I worked at St. Catherine’s. You never once asked what I did.”
Her mouth opened.
Nothing came out.
A surgical resident hurried around the corner.
“Dr. Carter, OR Two is ready. Perfusion is priming.”
“Thank you.”
He disappeared again.
Margaret whispered, “Doctor Carter?”
“Yes.”
“What kind of surgeon are you?”
Daniel answered.
“The kind your brother needs.”
Margaret looked at him.
He finally said the sentence he’d apparently wanted to say for months.
“Mom, Emily is chief of cardiothoracic surgery.”
Margaret sat down.
Not elegantly.
She simply missed the chair behind her and caught the armrest at the last second.
I almost went to help.
Daniel did.
“Chief?” she repeated.
“Yes.”
“How long?”
“Two years.”
“And before that?”
“A surgeon.”
Her eyes filled.
The cruelty of the evening suddenly returned to me.
The back table.
The patronizing compliments.
She’s just a nurse.
I didn’t feel triumphant.
That surprised me.
I had imagined this revelation before, usually after one of Margaret’s little comments.
I thought there might be satisfaction.
Instead, I saw a terrified woman whose brother could die in the next hour.
So I crouched in front of her.
“Margaret.”
She looked at me.
“What matters now is Arthur. He is very sick. But he got here quickly, and we have a chance.”
“A chance?”
“Yes.”
“How good?”
“I won’t lie to you. His risk is significant. His heart has already stopped twice.”
She began crying.
The first tears I had ever seen her shed.
“Please.”
I knew exactly what she meant.
Please save him.
No surgeon should promise that.
So I didn’t.
“I will do everything medically possible.”
She reached for my hand.
I let her take it.
“Please, Emily.”
“I know.”
Then I stood and walked toward the operating room.
At the doors, Daniel caught up with me.
He kissed my forehead.
“I love you.”
“I love you too.”
“You okay?”
“No.”
He smiled sadly.
“Good answer.”
“Your uncle might die on my table.”
“He also might live because you’re there.”
I looked through the glass toward OR Two.
“My team is there.”
Daniel squeezed my hand.
“Then go be their chief.”
Twenty minutes later, Arthur Whitmore’s chest was open beneath my hands.
His heart was failing.
May you like
And outside the operating room, the woman who had spent six months treating me like an embarrassing compromise was about to discover that wealth could buy almost anything.
Except control.
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