Under the Knife(57)

“Lo siento, se?ora,” Nikhil murmured in her ear. He glanced at Rita, then at the students, observing with wide eyes a few feet away. “That’s propofol. Related to barbiturates. We use it to induce amnesia. It burns sometimes, going into the vein.”

The students nodded solemnly.

Mrs. Sanchez stilled, and her closed eyelids fluttered. Her hand went limp, and Rita laid it gently on the table at her side.

Nikhil chased the propofol with a syringe full of clear fluid.

“That’s rocuronium,” Nikhil explained to the students. “A neuromuscular blocking agent. Takes effect in about forty-five seconds. It will paralyze her muscles. All of them, including her diaphragm. Which means she won’t be able to do what, Leah?” He pointed to the young woman.

“Um. Breathe?” Leah said.

“Yes. Excellent. Breathe. On her own, at least. We’ll have to do the breathing for her, with this respirator.” He pointed to a steel box the size of a small refrigerator, to which several gas cylinders marked O2 FLAMMABLE were attached with hoses. “The paralysis will allow us to control her blood oxygen levels and keep her from moving. And this—”

He held up a drug vial containing a clear liquid. “This is sugammadex. It will reverse the paralysis, within about three minutes of injection, at the end when we want her to wake up.”

Nikhil laid the sugammadex vial aside and hefted a metallic instrument composed of a handle attached to a long, curved hook with a tapered end.

“Nathaniel,” he said. The other student snapped to attention. “What’s this?” Nikhil wiggled the instrument back and forth.

“A … laryngoscope?”

“Correct. What’s it for?”

“To help you, ah—put in the endotracheal tube. So she can breathe.”

“Correct. Nice work. Both of you.”

The students exchanged looks, and Rita didn’t need to peek underneath their masks to know they were grinning.

“Now watch, because eventually I’m going to expect you to be able to do this on your own.” Leah and Nathaniel pressed in closer. Nikhil pried open Mrs. Sanchez’s limp jaws with his left hand; with his right, he slipped the curved tip of the laryngoscope between her teeth, yanked the handle up toward the ceiling, then pointed into the inside of her mouth with his left. “See that? The circular opening with the white bands?” Leah and Nathaniel nodded. “That’s her trachea. Goes straight to the lungs. That’s where the endotracheal tube goes.”

Dr. Chow, who’d been observing silently, stepped forward and pressed a plastic tube the length of a grade-school ruler into Nikhil’s free hand. He slid the tube into Mrs. Sanchez’s mouth and pulled the laryngoscope free.

Nikhil had wielded the laryngoscope with a deft touch, as fine as any of the anesthesiologists Rita had seen; but when he removed it, a thin coat of blood stained its silvery tip, where the metal had scuffed the soft skin lining the inside of Mrs. Sanchez’s throat.

“Nicely done,” Dr. Chow observed.

Rita agreed. She also wondered, not for the first time, whether patients would ever agree to surgery if they knew, really honest-to-God understood, the kinds of things doctors did to them in operating rooms.

Nikhil connected the endotracheal tube—a few inches of which stuck out of Mrs. Sanchez’s mouth, as if she were sucking on a length of PVC pipe—to the respirator and glanced at his monitors. He placed a stethoscope on Mrs. Sanchez’s chest and listened through it.

“Good to go?” Rita asked.

He flashed her a thumbs-up. “You’re all set.” Using a fabric harness, Nikhil fixed the endotracheal tube in place, so that it wouldn’t pull out of her mouth, and taped her eyelids shut with strands of silk tape.

Lisa drew the operating-table restraining straps around Mrs. Sanchez—

(The same straps the EXACT same straps that were around me this morning)

—one across her upper thighs, another across her chest, and buckled them into place.

The straps. She couldn’t take her eyes off them.

Lisa gave each of the straps a good firm tug—

(Naked I was NAKED)

—to make sure they were snug.

A wave of nausea accompanied a sour taste in her throat as she thought of herself stretched out on that table. God, what was she doing here?

I need to operate on Mrs. Sanchez.

Yes, but why? The urge was irresistible and incomprehensible. Her heart pounded in her ears; sweat broke out across her body. She was panicking, spiraling again toward madness.

Darcy. No matter what else happens, think about Darcy.

She had no choice. She had to keep going. Because of Darcy.

And because I need to operate on Mrs. Sanchez.

Nikhil was still lecturing the students. Rita took deep breaths and focused on what he was saying, trying to keep her mind occupied with something, anything, other than those damn table straps.

“This is isoflurane,” he said, patting a large metal canister located next to the respirator that, like the oxygen tanks, was fastened to it with hoses. “Isoflurane, and gases like it, produce the profound unconsciousness—a kind of reversible coma—needed for surgery. Paralysis drugs, like rocuronium, don’t induce unconsciousness. You need the gas to knock a patient out.”

“Can isoflurane, or any of these other tanks of gas, explode?” Leah asked.