Chapter Ninety-Two

Trapper pushed through the door of the exam room to find a very pregnant patient flanked by two doctors. “What have we got?” he asked, stepping to the end of the bed.

Stanley read the chart. “Thirty-two year-old, around thirty-six weeks, having contractions. But look at this, John.”

Moving over to the right side of the bed, Trapper looked at the top right of the woman’s belly where Stanley indicated. “Looks like abdominal distension with hepatomegaly,” he said, palpating the area. “How’s her blood pressure?”

“Ninety over sixty-two.”

Picking up her hand, he looked at her fingernails. “Is the blood work back from the lab?”

“No, not yet.”

“All right, let me know when it is. I’m looking for anemia, low platelets and elevated liver enzymes.”

“What do you think?” asked Stanley.

Trapper leaned on the bed with his hands on the short rails and looked Stanley in the eye. “I hope I’m wrong, but it looks like a ruptured liver. Let’s get a CT scan of the upper right quadrant. Who’s her OB/GYN?”

“Howard Davies, but he’s out of the country.”

“Get Angela Reyes down here. It could be time for this baby to meet the world. If the CT scan comes back positive, we won’t have much time.”

Stan nodded at the nurse, who left the room. “For mother or baby?”

Heading for the door, Trapper turned back. “Both. Is her family here?”

“Husband…Miller…in the waiting room,” answered Stanley while writing in her chart.

Trapper stopped at the nurse’s station and found Gloria on shift. “Gloria, I need an OR, I need Ernie to set up for liver repair or lobectomy, and I need a delivery setup.” Without stopping, he continued on to the waiting room. “Mr. Miller?”

A young man stood up and walked toward Trapper. “Here.”

“Mr. Miller, I’m Dr. McIntyre…”

“Are Liz and the baby all right?”

Moving a hand to Miller’s shoulder, Trapper walked him out of the waiting room and down the hall to the alcove by the water fountains. “Mr. Miller, was your wife having contractions when you brought her in?”

Miller furrowed his brow. “Yes. That’s why I brought her in.”

“Is this her first child?”

“We’ve lost one before…in the first trimester. That was five years ago. Dr. McIntyre, are you an OB/GYN?”

“No,” said Trapper, smiling. “I’m a cardiothoracic surgeon. I was called because of some unusual pain your wife is experiencing. She has some swelling on her right side above her stomach which I believe is a problem with her liver.”

Mr. Miller fell back against the wall. “God, no.”

“I’m waiting on a CT scan to confirm that, but I want to prepare you and her in case we have to go in.”

“Go in! She’s pregnant. How are you going to go in?”

“Now calm down. She’s almost due. If there is a problem with her liver, we’ll do a vertical cesarean section, and then go in right after to take care of her liver.”

“Take care of her liver…what does that mean?”

“Because of the swelling, I believe it may be ruptured, and if so we’ll have to do some repairs. If it is ruptured and we can’t stop the bleeding, we may have to take part of it…” Miller sucked in a breath and ran his fingers through his hair. “But she can live a normal life with a partial liver. Now, I need you to sign some consent forms. We won’t do anything until we get her blood work and CT scan back to confirm the diagnosis, but if this is a ruptured liver, we have to act fast to get the bleeding stopped.”

“Of course…anything. Just tell me where I need to go.”

“Come with me. I’ll have one of the nurses go over the forms with you.” When they got back to the nurse’s station, Trapper introduced him to another nurse there, and added finding Gonzo to Gloria’s list.

***

When Leah sat down in front of her desk, the first thing she did was write her list. Angela Bowen, Albert Shaeffer, Leo and Carlotta Costa, and Ernestine Shoop. She sighed, moved the list to her lap drawer and pulled a stack of paperwork in front of her. First on her list were the change requests from the hospital departments. She needed to ensure her people had adequate work during the system updates for the silo. Picking up the phone, she dialed David Stern who was still acting technical lead. “David, this is Leah. Would you please come up to my office? I have some work I’d like to discuss with you. Yes, now.”

Sitting back in her chair and bouncing the eraser of her pencil gently on her lips, she thought back to how the conversation ended in the cafeteria. As he had done so many times before, he stopped talking and eating, kissed her and left for whatever emergency needed his expertise this time. But did it matter? Wouldn’t she have done the same if there had been a problem in the data center? In their positions of authority, this was normal. Why did it bother her?

Then Doug Manning crept in again. Something about him had frightened her this time. She certainly knew him to be a vengeful man. She had seen him in action numerous times during her employment with Manning Consulting. But that was along the lines of career assassination; something she knew he wouldn’t get away with in her case, and something he wouldn’t be able to even begin with Trapper. Was he capable of doing physical harm though?

She was still shaking her head when David tapped on the door. Turning her chair forward, she put on a smile. “David, please come in. You and I have a great deal to talk about.”

***

Gonzo stepped beside Trapper at the scrub sinks just as Trapper was shaking the water off his hands. “Glad you could join us,” said Trapper, nodding toward Ernie who had just finished washing.

“Sorry. I just finished a peritoneal port for a dialysis patient. I guess it’s a good thing I don’t have to go to the little boy’s room.”

Trapper opened his mouth to make a remark, but closed it and shook his head. “Dr. Reyes is already in the OR preparing for a C-section. You and I are going to take over after the child is separated from the mother and repair a ruptured liver. Take a good long look at the CT scan when you go in. The rupture at the far right of the right lobe was probably caused by the labor contractions.”

Trapper pushed backwards through the doors where a nurse was waiting with gloves, mask and surgical robe. Ernie was right behind him, and once she donned the appropriate garb, she began to assemble her tray.

Trapper moved behind the end of the table where Dr. Reyes had just completed the cesarean incision. “How are you doing, Dr. Reyes?”

A smile touched her eyes. “We’re ready to take the baby. Would you like to assist?”

“I don’t often get to deliver babies. It would be my pleasure,” he said, returning the smile.

“All right. I’m going to reach in and pull the baby out. I need you to watch the incision and help all the body parts come through smoothly, and then you can cut and clip the umbilical cord. Here we go.”

As cesareans go, this particular one turned out to be fairly routine. There was a small celebration as the umbilical cord was cut and the baby was passed to the waiting hands of a nurse. Once Dr. Reyes had sutured the uterus, she turned the patient over to Trapper and his team.

“Get me a fresh pair of gloves,” he said as he turned for the current ones to be removed. He looked from Gonzo to Ernie. “Everyone ready?” Receiving nods, he asked the anesthesiologist, “How’s her pressure?”

“One ten over sixty.”

“Not bad. How many units have you used?”

“Still on the first one. I have three more available.”

“Alright, let’s see what we can see with this incision. Tissue retractors.” Before he finished his request, Ernie had placed them firmly in his hand. He glanced at her, and though she couldn’t see because of his mask, he turned up the corner of his mouth. “Gonzo, do you see what I see?”

“Yeah. It looks like a mass, but there’s a lot of blood around it. Hemangiomas don’t usually bleed.”

“Mm hm. It’s definitely not what caused the distension. Move suction to the right,” he said as he lifted the mass. “There’s the rupture…behind the mass.” He groaned. “We’re going to have to remove the mass before we can repair the rupture. “I’ll resect. You suture behind me.”

***

By the time Trapper walked back into his office, it was seven in the evening. The liver resection had taken longer than he would have liked. With both he and Gonzo working together, they still had trouble stopping the bleeding, but finally managed. He spent another hour with Mr. Miller explaining the procedure, complications and recovery. At least the young man had the baby, who was doing remarkably well, to smile about.

He walked into his private bathroom and splashed water on his face, then went to his desk to find a note sitting dead center. Trapper, I’ve taken a cab to the pool house. If it’s not too late when you leave, come by…if you want. I’ll be in bed by eleven. I put your sandwich from lunch in your mini-fridge, just in case you didn’t have a chance to eat dinner. –L

He smiled at first, but his smile slowly faded. “If I want?” Tossing his slacks, shirt and tie over his arm, he left the paperwork that awaited him on his desk as well as the sandwich in the fridge and left the hospital.